Using a Novel Method to Quantify and Confirm the Variable Vertical Vector of the Deep Plane Facelift.

Background: In deep plane rhytidectomy, it is accepted that a more vertical vector will lead to a more natural rejuvenated look than a horizontal vector of pull. Objective: Among patients undergoing deep plane rhytidectomy, can skin angle measurements designed by the authors be used as a proxy for vector of tension to confirm a vertical vector? Methods: Case series measuring the rhytidectomy vector of pull for a series of patients performed by a single surgeon. Results were compared between the vectors of the pre- and postauricular flaps as well as comparing the vector of pull in male versus female patients, patients undergoing facelift alone versus in conjunction with other rejuvenation procedures, and between primary versus revision rhytidectomy patients. Results: Patient characteristics: Average age 64.4 (range 47-79), predominantly female (26/28, 92.9%), primary rhytidectomy (24/28, 85.7%), with concomitant brow lift (12/28, 42.9%). Results reveal a more vertical than horizontal vector of pull on both the pre- and postauricular superficial musculoaponeurotic system flaps with the vector of the anterior flap being more vertical than that of the posterior flap. Conclusion: Utilizing a novel proxy measurement, the vector of pull of the deep plane facelift was more vertical than horizontal.

Deep Endometriosis of the Terminal Ileum Presenting With Cyclic Recurrent Small Bowel Obstruction.

Here, we discuss a case of a 42-year-old premenopausal female who presented with chronic pelvic pain and recurrent small bowel obstruction during menstruation. The patient reported a nine-year history of pelvic pain and a four-year history of episodic small bowel obstruction requiring multiple prior inpatient admissions. During these admissions, the obstruction was managed conservatively with bowel rest and nasogastric tube placement; however, symptoms would recur with subsequent menstrual cycles. Computed tomography showed diffusely dilated loops of small bowel with a transition point in the central anterior pelvis, and magnetic resonance enterography revealed a mass-like area involving small bowel loops in the mid pelvis. The patient underwent laparoscopic surgical intervention including bowel resection with re-anastomosis, hysterectomy, bilateral salpingectomy, and left oophorectomy. Intraoperative findings included severe distention of the proximal bowel with a discrete deep endometriosis lesion of the terminal ileum which was confirmed on final pathologic examination. This case emphasizes the importance of considering endometriosis as the etiology of recurrent catamenial small bowel obstruction, particularly in premenopausal women.